DI1.pptx lecture slide for bachelor students
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DI1.pptx lecture slide for bachelor students
- 1. MR YOGENDRA MEHTA LECTURER, HOD(AHD) BRNC Diabetes Insipidus
- 2. DEFINITION It is a disorder of water metabolism caused by deficiency of ADH (Vasopresin) or by inability of the kidneys to respond to ADH.
- 3. FORMS OF DI 1. Transient DI: Abrupt onset within first few after neuro surgery resolve within several days. 2. Permanent DI: Abrupt and early onset, persists for several weeks or forever. Usually occurs after damage to hypothalamus or Neurohypophyseal damage.
- 4. CONT…. 3. Triphasic DI: Immediate post injury increases Urine volume with decrease in urine osmolity lasting 4-5days and followed by permanent phase of polyuria. 4. Nephrogenic: Rare Hereditary disorder acquired structural or functional changes in kidney occurs. ADH produced normally, but distal and collecting tubules cannot respond.
- 5. CONT…. 5. Complete DI: When there is disruption of hypophyseal tract and a complete absence of ADH. 6. Neurogenic DI: CNS interruption of anatomic integrity of posterior pituitary. ADH synthesis or release is affected, may be transient or permanent. 7. Idiopathic DI:
- 6. ETIOLOGY 1. Primary – Idiopathic 2. Secondary Head trauma Neuro surgery Tumors (Intra cranial) Vascular Infection (Meningitis) Longstanding renal disease Hypokalemia.
- 7. PATHOPHYSIOLOGY Due to etiological factor Deficiency of ADH Permeability of water is diminished Excretion of Large volumes of hypotonic fluid
- 8. CONT…. Note: Normally ADH increases kidneys permeability to water to promote water reabsorption and decrease urine output. ADH is normally released in response to increase serum osmolality and decrease Extracellular volume.
- 9. CLINICAL MANIFESTATION i.Genito Urinary : * Polyuria (few liters to 18 l/day ) * Clear urine * Urinary Frequency * Nocturia ii. Gastro Intestinal: *Weight loss * Polydipsia (if thirst mechanism intact 4 to 40 l/day) * Has craving for cold water.
- 10. CONT…. iii.Integumentary: *Dry skin and mucous membrane iv. Neurologic: * Electrolyte Imbalance * Hypotention v. High serum osmolality vi. High serum sodium level.
- 11. DIAGNOSTIC EVALUATION History collection Physical Examination Water deprivation test Hyper-tonic Saline test Urine output Serum Na+ level Plasma and Serum Osmolality
- 12. MEDICAL MANAGEMENT Administration of ADH or its derivative: a) Vasopressin (Pitressin) - IM, Effective for 24 to72hrs. - Vial should be warmed and shaken vigorously before administrating to mix active component settles at bottom of vial. b) Lypressin (Diapid nasal Spray) - Absorbed through nasal mucosa - Duration of action 4 to 6 hrs - may cause chronic nasal irritation.
- 13. CONT…. c) Desmo-pressin acetate. - Vasopressin deratives administered into the nose through a soft, flexible nasal. - Duration of action 12 to 24 hrs - For patient who have some residual hypothalamic ADH. d) Chloropropamide: - Potenciate action of reducing polyuria. e) Hydro – Chlorothiacin: - Reduce the urine volume - Dose 20 – 75 mg /kg/day
- 14. SURGICAL MANAGEMENT 1.) Hypophysectomy:- - Removal of pituitary gland may be performed for the treatment of primary tumor of the pituitary gland.
- 15. COMPLICATION Electrolyte imbalance Hypotension Hypovolemia Shock Death
- 16. NURSING DIAGNOSIS Risk for fluid volume deficit r/t disease process. Imbalanced Nutrition Less than Body Requirements related to insufficiency of insulin, decreased oral input. Fluid Volume Deficit related to osmotic diuresis. Risk for Infection related to hyperglycemia.